I fell into writing about health shortly after grad school, where I realized I didn't want to work in a lab for the rest of my life! My areas of interest are the brain and behavior, as well as what influences the decisions we make about our health, and how the media helps and hinders people's understanding of health issues. As an undergraduate, I studied English Literature and Biopsychology at Vassar College, and got my PhD in Biopsychology and Behavioral Neuroscience at CUNY's Graduate Center in New York City, where I grew up and live now. My day job is as Associate Editor with the health website, TheDoctorWillSeeYouNow.com. My work has appeared in several other publications, including TheAtlantic.com and YogaGlo.com, and I'm particularly excited to join the Forbes health team. Email me at alicegwalton [at] gmail [dot] com .

Cutting Heart Risk From Obesity: Treat The Symptoms Or The Cause?

A huge new study out today in The Lancet shows that reducing three key factors linked to obesity – high blood pressure, blood sugar, and cholesterol – could cut heart disease in obese people by half. The factors are known separately and together to significantly increase one’s risk for heart disease and stroke, and they’re often the products of being overweight or obese. The new study is one of the most comprehensive to show the tight link between these risk factors and heart and stroke risk. But the remaining question is whether addressing these factors – essentially the symptoms of obesity themselves – is really the best fix.

The study, from Harvard’s School of Public Health, looked back at 97 earlier studies including 1.8 million participants across the globe and spanning the years 1948 to 2005. There were more than 57,000 deaths from coronary heart disease and 31,000 deaths from stroke over this time. The team calculated the additional risk that having high blood pressure, blood sugar, and/or cholesterol had on heart and stroke risk in people with high body mass index (BMI).

Not surprisingly, being overweight or obese significantly upped one’s risk of heart attack and stroke.

But it turned out that the “big three” – high blood pressure, high cholesterol, and high blood sugar – explained almost half of the increased risk for coronary heart disease and three-quarters of the increased risk for stroke in overweight and obese people. High blood pressure had the biggest effect, accounting for 31% of the increased risk of heart disease and 65% of the risk for stroke.

The team suggests that controlling these three factors could have a huge impact on the risk of heart disease and stroke that obesity poses: “Our results show that the harmful effects of overweight and obesity on heart disease and stroke partly occur by increasing blood pressure, serum cholesterol and blood glucose,” said senior author Goodarz Danaei in a statement. “Therefore, if we control these risk factors, for example through better diagnosis and treatment of hypertension, we can prevent some of the harmful effects of overweight and obesity.”

Some, but not all. The problem with this logic is that treating the symptoms of obesity, rather than the cause, only works in part. These risk factors – high blood pressure, cholesterol and blood sugar – are part of the metabolic syndrome, which is well known to be a byproduct of obesity and to increase considerably one’s heart, stroke, and mortality risk. Therefore, zeroing in on these three issues by themselves is a bit like band-aiding the problem, rather than getting to its cause – obesity. The authors even say that treating overweight people is more effective than treating obese individuals, who “also benefit from interventions on mediators but will continue to have significantly raised risk.” There are certainly other variables that account for the remainder of the increased heart and stroke risk.

Majid Ezzati, co-author of the study, agrees that treating the three risk factors is only a partial fix. “Controlling hypertension, cholesterol, and diabetes will be an essential but partial and temporary response to the obesity epidemic,” she said. “As we use these effective tools, we need to find creative approaches that can curb and reverse the global obesity epidemic.”

This means more effective behavioral tools and interventions, along with access to more nutritious foods, to help solve the problem in a real way. The authors say that 3.4 million annual deaths are likely due to being overweight or obese. It seems much wiser to treat the underlying causes – which have to do with poor habits and lack of resources – than to medicate the symptoms.

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